Hyperbaric fellows will be trained in the emergency clinical use of hyperbaric oxygen. This includes the emergency treatment of clostridal myonecrosis, necrotizing fasciitis, arterial gas embolism, decompression sickness, carbon monoxide poisoning and certain other less common conditions such as acute vasculitis with ischemia. Fellows will receive training in the appropriate critical care interventions necessary for the treatment of these patients. This will include hemodynamic monitoring, ventilatory support, fluid resuscitation and the interpretation of arterial blood gases during hyperbaric therapy. Fellows are also trained in the use of hyperbaric oxygen therapy for non-emergency conditions and chamber operations and maintenance.
This expanded fellowship has fellows primarily based in one location but rotating to the sister institution for two to four months of their fellowship year. Fellows rotating to Duke will receive the benefits of Duke’s large clinical service, highly organized didactic program and active human physiology research program. Fellows rotating to Utah will be exposed to environmental conditions (altitude) and clinical case not readily available at Duke including: mono-place hyperbaric care for ventilated critically ill patients, hyperbaric therapy at high altitude and aviation decompression sickness patients from the US Air Force.
In light of the distance between the two training sites, each fellow will be assigned a primary location in either Utah or North Carolina. However, they will travel to the other institution for two to four months of their 12-month fellowship year. All fellows will have the same expectations and performance requirements, including conducting a research project and submitting a manuscript for publication. Moreover, all fellows will participate together in the same didactic program including bi-weekly teaching conferences, the formal courses such as Duke CBI 206, (The Medicine and Physiology of Extreme Environments) and the HBO grand rounds conferences currently offered by the Duke program. This will be accomplished by using the distance-learning techniques currently employed at Duke for the ongoing monthly Pan-fellowship teaching conferences. Upon successful completion of the training year, all fellows will receive a Duke diploma.
During the training period, fellows are responsible for all inpatient and outpatient consults, under the direction of the clinical hyperbaric faculty. They will also be required to complete a research project or another project of similar academic rigor. This will be completed under the guidance of one of the faculty members of The Duke Center for Hyperbaric Medicine and Environmental Physiology. Part of the fellowship didactic program includes regular hyperbaric conferences. Fellows will participate in these and be required to present on at least two topics during the year of training.
Hyperbaric fellows traditionally spend two weeks at the Undersea and Hyperbaric Medical Society / National Oceanic and Atmospheric Administration (UHMS / NOAA) physician’s diving medicine course in Seattle, Washington where they become International Marine Contractors Association / Diving Medical Advisory Committee (IMCA DMAC) Level II certified, allowing them to examine for fitness to dive and treat commercial diving related injuries worldwide. As part of the course they learn to operate different chamber types (see photo below). As a highlight, they make an actual dive in commercial diving gear at NOAA’s 35-foot dive tower at the Sandy Point Facility on Lake Washington.
Fellows from left to right are: Peter Ceponis MD, Clinton Keilman MD and Chris Guerry MD.
In addition to the above activities, the applicant will participate in numerous other teaching activities within Duke Medical Center, including those sponsored by the Departments of Anesthesiology, Medicine, Surgery, Emergency Medicine and Occupational Medicine. Clinical participation under the aegis of those departments can be arranged in some cases, depending upon the training of the individual concerned. Fellows will also supervise and manage the didactic curriculum for visiting medical students, interns and residents.
Patients with a variety of ailments are referred to the hyperbaric center from the clinical services at Duke. Board certified physicians in Undersea and Hyperbaric Medicine from the Departments of Anesthesiology and Medicine provide 24-hour clinical coverage. Approximately 8,000 hours of hyperbaric oxygen (HBO) treatments are provided annually to more than 300 patients. Patient mix consists of both adult and pediatric inpatients and outpatients, ambulatory and ICU. Treatments are provided for decompression sickness, air embolism, acute carbon monoxide poisoning, gas gangrene and other necrotizing infections, chronic osteomyelitis, acute ischemic syndromes, e.g. crush injuries and salvage of surgical flaps, and late complications of radiotherapy, e.g. osteoradionecrosis and soft tissue radionecrosis. The center also serves as a referral point for the treatment of pulmonary alveolar proteinosis (PAP), a rare lung disorder of unknown etiology.